- 作者列表："Trager MH","Queen D","Samie FH","Carvajal RD","Bickers DR","Geskin LJ
:Skin cancer affects 1 in 5 Americans, resulting in significant morbidity and mortality. Treatment costs and rates of skin cancer and melanoma continue to rise, making preventative measures increasingly important. However, there is conflicting evidence about efficacy of primary and secondary prevention strategies in decreasing incidence and improving early diagnosis. The US Preventative Services Task Force 2016 guidelines did not endorse routine skin cancer screening because of "insufficient evidence." Yet, countries like Australia have shown the feasibility and cost-effectiveness of primary sun safety interventions and secondary prevention measures such as routine skin cancer surveillance. Additional emerging evidence shows that regular skin cancer screening in high-risk populations improves early detection and decreases melanoma mortality. New technology may enhance prevention, promote accurate diagnoses, and improve management of melanoma and nonmelanoma skin cancers. Here, we place rising rates of melanoma within historical context, review costs, efficacy, and evidence for primary and secondary skin cancer prevention and examine the evolving role of novel technologies in the field.
: 皮肤癌影响五分之一的美国人，导致显著的发病率和死亡率。皮肤癌和黑色素瘤的治疗费用和发病率持续上升，使得预防措施变得越来越重要。然而，关于一级和二级预防策略在降低发病率和改善早期诊断方面的疗效，存在相互矛盾的证据。美国预防服务工作组 2016 指南不支持常规皮肤癌筛查，因为 “证据不足”。然而，像澳大利亚这样的国家已经表明了初级阳光安全干预和二级预防措施如常规皮肤癌监测的可行性和成本效益。其他新出现的证据表明，在高危人群中定期进行皮肤癌筛查可提高早期发现并降低黑色素瘤死亡率。新技术可能增强预防，促进准确诊断，并改善黑色素瘤和非黑色素瘤皮肤癌的管理。在此，我们将黑色素瘤发病率上升置于历史背景下，回顾原发性和继发性皮肤癌预防的成本、疗效和证据，并检查新技术在该领域不断发展的作用。
METHODS::Blue rubber bleb naevus syndrome (BRBNS) is an extremely rare venous malformation that often manifests as multiple haemangioma-like lesions in the skin and gastrointestinal tract. The drug sirolimus plays a key role in the signalling pathway of angiogenesis and subsequent development of BRBNS and its use has been described in several case reports. We present a case series of four patients with BRBNS who exhibited good treatment response to sirolimus. All four patients were administered oral sirolimus at doses of 1.0-1.5 mg/m2 /day with a target drug level of 5-10 ng/mL and median treatment duration of 20 months. All patients had a reduction in the size of the lesions and a normalization of coagulopathy with tolerable drug adverse reactions at follow-up. Sirolimus may be effective and safe in paediatric patients with BRBNS. Further prospective studies are suggested to evaluate the long-term effectiveness of this drug.
METHODS:BACKGROUND:Human papillomavirus (HPV) infections are associated with common dermatologic and nondermatologic diseases. Although HPV vaccines are well established as preventive measures for genital warts and cervical neoplasia, their use as therapeutic agents deserves greater attention. OBJECTIVE:To evaluate the use of HPV vaccine(s) as a treatment modality for cutaneous and/or mucosal disease. METHODS:A primary literature search using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was conducted in January 2019 by using the PubMed and Cochrane databases. RESULTS:A total of 63 articles with 4439 patients were included. The majority of patients with cutaneous warts, recurrent respiratory papillomatosis, and squamous and basal cell carcinomas were successfully treated with HPV vaccination. Preliminary data on patients with pre-existing anogenital warts, cervical intraepithelial neoplasia, anal intraepithelial neoplasia, and vulvar intraepithelial neoplasia is promising. LIMITATIONS:This review was limited by the lack of controls, patients' previous HPV vaccination status, and publication bias. CONCLUSION:The commercially available three-dose, quadrivalent HPV vaccine is a potential therapeutic option for the treatment of cutaneous warts, recurrent respiratory papillomatosis, and squamous and basal cell carcinomas. Noncommercially available HPV vaccines demonstrate therapeutic response for treating anogenital warts, cervical intraepithelial neoplasia, anal intraepithelial neoplasia, and vulvar intraepithelial neoplasia. The vaccine's efficacy as an adjunct therapy for HPV-associated cutaneous and/or mucosal disease warrants further exploration.
METHODS::Our understanding of melanoma precursors and progression to melanoma has developed as a result of advances in the field of molecular diagnostics. We now better understand the potential for genetic heterogeneity within a single lesion. Combined tumors can pose a diagnostic challenge when deciding the line between benign and malignant, which in turn has direct implications for patient management. Primary cilia (PC) are ubiquitous sensory organelles that have essential functions in cellular proliferation, differentiation, and development. The ciliation index (percentage of ciliated melanocytes) has been shown to reliably differentiate melanoma, which fail to ciliate, from melanocytic nevi, which retain PC. We therefore analyzed the potential for using the ciliation index to differentiate benign and malignant components in combined melanocytic lesions. We collected patient samples (n = 10) of unequivocal combined lesions with both melanoma and associated nevus components. Melanocytes were highlighted with SOX10 and costained with gamma-Tubulin and acetylated alpha-Tubulin to highlight the basal body and cilium, respectively. The number of melanocytes retaining cilia under high-power microscopy was examined. The melanoma component had average of 4% ciliation (SD: 7%), whereas the associated nevus component was significantly higher with 59% ciliation (SD: 17%). These data show that PC may be a reliable means of distinguishing benign from malignant components within a single tumor. The ciliation index may be a helpful tool in distinguishing challenging cases of combined lesions of melanoma in situ with a dermal nevus component from invasive melanoma, thus promoting improved staging and clinical management.